Tuesday, February 12, 2013

We urge the governor to expand Medicaid program

A key provision of Obamacare is an expansion of this program for the poor. Wisconsin should not be left behind.

Feb. 11, 2013 6:05 p.m.

Wisconsin should expand its Medicaid program through the Affordable Care Act.

If Gov. Scott Walker decides to do that, more than 100,000 people would be affected,
nearly all of them either unemployed or only working part time. That
single act could save lives - and may save money in the long run if it
leads to better health care.

While
advocates for the poor argue passionately for the governor to take this
step - and we agree it's the right one - the decision is not as
clear-cut as those advocates would have you believe. There are risks in
expanding the program, a decision that was left to the states by last
summer's U.S. Supreme Court ruling that upheld Obamacare. Walker is
expected to announce his decision in a matter of days.

For
one, while federal money covers the full cost of Medicaid expansion
from 2014 to 2016, the federal share will gradually decline to 90% in
2020. There are concerns that even that 90% share might be in danger in
an era of austerity, and even with a 90% match, the additional burden on
the state purse would be substantial.

Critics
are correct in arguing that expanding Medicaid does nothing to attack
the very real problem of controlling out-of-control costs in the
American health care system. They are also correct that shifting the
burden from Wisconsin to the federal government doesn't relieve the
state's taxpayers, who also pay federal taxes (although the state may be
able to shift significant costs to the feds in future years).

And
there surely are problems with access to health care for the poor -
simply having insurance, whatever the form, does not ensure good care if
there aren't enough physicians or clinics seeing the poor.

Nevertheless, Walker should expand the program.

Expansion
of Medicaid is one of the key provisions of the Affordable Care Act.
The program would expand to include people with household incomes below
138% of the federal poverty line ($15,414 for an individual this year)
who are not now eligible for coverage. BadgerCare - Wisconsin's Medicaid
program - already is more generous than that, but many low-income
people without children or whose kids are grown still fall between the
cracks. Recently, the waiting list to get on BadgerCare ballooned to
140,000. Low-income folks don't have good options for affordable health
insurance any other way - a lot of low-wage jobs simply don't provide
it.

And
while there surely will be an additional cost to the state's taxpayers
after the initial period of federal support, those costs will be
moderated if more of the poor are seen earlier and get better
preventative health care. Left untreated, chronic illnesses such as
diabetes only worsen - and get much more expensive to treat. Health
insurance, in that sense, saves money. Yes, access is a problem in urban
areas such as Milwaukee, but that's a separate challenge and is no
argument for failing to cover people who need it. Expanding Medicaid
also could reduce the cost of bad debt and charity care, although the
extent of those savings isn't known.

In addition, the state would leverage billions of dollars more
in federal assistance. The state would save $66 million in the first
three years of the program but pay back those savings and pay up to $67
million more over the next four years, a nonpartisan Legislative Fiscal
Bureau study shows. But an estimated $4.38 billion in federal money
would become available to provide health care through 2020, the bureau
reports.

Opponents of Medicaid expansion argue that a so-called "woodwork" effect will lead many people to sign up who currently are eligible but not receiving Medicaid. But as the Fiscal Bureau recently noted in its report, that is likely to happen anyway, whether Medicaid expands or not. And if they are eligible, they should be covered.

This
can't be an easy call for a governor so opposed to Obamacare, but we
think it's the right one and hope he sees it that way, too. Both sides
agree that expanding Medicare will save lives. It will bring billions of
dollars of federal money to a state that historically has lagged in
that key category. The added expense, which will be moderated by better
care and federal money, is worth it.